Optimal Provision Research Articles

Real-time optimization of active distribution networks with distributed energy resources participating in frequency regulation

Dispatchable distributed energy resources (DERs) in distribution networks are envisioned to aid frequency regulation for transmission systems. In this paper, a real-time optimal dispatch framework for DERs in distribution networks is designed to offer frequency regulation services simultaneously. Different from the existing research that distribution networks track uniaxially the predetermined auxiliary-services commands of the transmission system, here we regard transmission system frequency regulation as a black box and learn the parameters of its proxy satisfaction function from the perspective of DER optimization. To solve such a special optimization problem with control performance feedback, first we employ Gaussian processes to learn the satisfaction function, and, especially, build pertinent upper confidence bounds to achieve the optimal provision of ancillary services. Next, the primal-dual gradient projection process is embedded into the Gaussian process upper confidence bound algorithm to pursue the optimal DER dispatch. Accordingly, the output powers of DERs can be controlled in real-time: in disaggregate mode, they meet the goal of the distribution network; in aggregate mode, they provide a more satisfactory tie-line power flow to the transmission system. Simulations for illustrative systems are provided to validate the approach.

Frequency-Constrained Resilient Scheduling of Microgrid: A Distributionally Robust Approach

In order to prevent the potential frequency instability due to the high Power Electronics (PE) penetration under an unintentional islanding event, this paper presents a novel microgrid scheduling approach which includes the system frequency dynamics as well as the uncertainty associated with renewable energy resources and load. Synthetic Inertia (SI) control is applied to regulating the active power output of the Inverter-Based Generators (IBGs) to support the post-islanding frequency evaluation. The uncertainty associated with the noncritical load shedding is explicitly modeled based on the distributionally robust formulation to ensure resilient operation during islanding events. The resulted frequency constraints are derived analytically and reformulated into Second-Order Cone (SOC) form, which are further incorporated into the microgrid scheduling model, enabling optimal frequency services provision from the micorgrid perspective. With the SOC relaxation of the AC power flow constraints, the overall problem is constructed as a mixed-integer SOC Programming (MISOCP). The effectiveness of the proposed model is demonstrated based on modified IEEE 14-bus system.

Generating key practice points that enable optimal palliative care in acute hospitals: Results from the OPAL project's mid-point meta-inference.

Internationally, the epidemiology of dying is changing with people dying at an older age from an expected death and with complex health care needs. An increasing proportion of people require hospital care with the need to strengthen the quality of this care well-articulated. Evidence about what enables optimal inpatient palliative care is available. Articulating how to enable this within clinical practice is required. To investigate the domains of care that are most important to inpatients with palliative care needs and their families, to generate key practice points to inform optimal clinical care provision. A mid-point meta-inference of the Opal Project's data. The three phase Opal Project utilised a fully mixed sequential dominant design (Quan→QUAL). Phase 1 focused on 'scoping the problem' through a systematic review and meta-synthesis of important aspects of care for inpatients with palliative care needs and their families (studies 1a and 1b); Phase 2 focused on 'understanding importance' through a qualitative interview study (study 2); and a mid-point meta-inference of data obtained across Studies 1a, 1b and 2. Phase 3 included a global environmental scan (Study 3) and co-design workshop (Study 4) focused on understanding how to drive reform for Australian inpatient palliative care, based on outcomes from the mid-point meta-inference; and an end-point meta-inference to generate final recommendations. Mid-point meta-inference of data obtained across Phases 1 and 2 involving: 1) verifying synthesis of data with palliative care consumers and clinical leaders; and 2) populating joint display tables to inform analysis and generate practice points. Three categories and 14 domains informing optimal inpatient palliative care were identified: 1) Person-centred care including respectful and compassionate care; effective communication and shared decision making; effective teamwork; enabling family involvement; and maintaining role, meaning and identity; 2) Expert care including excellence in physical care; impeccable assessment and care planning; effective symptom management; technical competence; patient safety; and supported access to senior clinicians; and 3) Optimal environment for care including patient and family focused structural factors; and cleanliness to support infection control. Data integration generated 68 practice points informing care provision. Through a synthesis of patient and family perspectives about what is important for optimal inpatient palliative care, this study confirmed three categories of care, 14 domains of importance and 68 practice points. Importantly, these practice points guide clinical practice to enable each domain of care in practice. We know what patients with palliative care needs, and their families need for good care when they are in hospital. It is time to deliver care in line with these needs.

Clinician and healthcare managers' perspectives on the delivery of secondary and tertiary pediatric weight management services.

Clinician and healthcare managers' (HCMs) views on weight management service delivery are imperative for informing the nature of future services to treat children with obesity. This qualitative study used semi-structured focus groups and one-on-one semi-structured interviews. Participants were 27 clinicians (medical, nursing, or allied health) and nine HCMs (senior executives in the hospital) who worked in six secondary or tertiary pediatric weight management clinics across five public hospitals in New South Wales, Australia. Clinicians reported that using a combination of group and individual sessions improved engagement with families and reduced attrition rates. Clinicians and HCMs recommended integrating clinics into community centers and providing specific programs for sub-groups, such as children from culturally and linguistically diverse communities or children with developmental delay. Many clinicians and HCMs stressed the importance of pediatric weight clinics using a holistic approach to treatment. To improve the likelihood of future funding for pediatric weight management clinics and to optimize models of care, centers must embed research into their practice. Addressing common barriers to current pediatric weight management services and designing future models of care based on key stakeholders' preferences is critical to achieving optimal care provision for this high-risk population.

Security‐constrained optimal scheduling and operation of island microgrids considering demand response and electric vehicles

As an independent unit, microgrid operator (MGO) should respond to the energy demand of customers with an optimal provision cost. Apart from the ability to guarantee the security of microgrid (MG) operation, the MGO should consider the greenhouse emission effects as well. This paper investigates a novel energy management system for an islanded MG. In the proposed strategy, two efficient methodologies are used to maximize the profit and security of the MG: (a) the optimal operation of electric vehicles (EVs) in vehicle-to-grid (V2G) mode and (b) the use of demand response (DR) program. Besides, a hierarchical control structure is proposed to manage frequency and voltage uncertainties in a permissible range. Improving the reliability of the MG is another goal of the proposed strategy, which is pursued by the studied controlling framework. The proposed approach is evaluated through a set of simulation and GAMS tests. Results indicate that the frequency deviation of the MG is damped through the proposed management strategy and place the spotlight on the effectiveness of the approach.

On the instability of private intertemporal liquidity provision

The provision of intertemporal liquidity by banks is known to be subject to coordination failures. We establish that asset markets providing intertemporal liquidity are also inherently unstable. These findings challenge the notion of an optimal private provision of liquidity.

Prevalence of PErioperAtive CHildhood obesitY in children undergoing general anaesthesia in the UK: a prospective, multicentre, observational cohort study

BackgroundChildhood obesity has become a serious global healthcare challenge. No UK data currently define its anaesthetic and perioperative implications. We aimed to determine obesity prevalence amongst UK children undergoing general anaesthesia and the incidence of predefined adverse perioperative events, and to compare perioperative obesity rates with National Child Measurement Programme (NCMP) data. MethodsDuring a site-selected consecutive 7-day study period, all children (2–16 yr) undergoing general anaesthesia were included. Anonymised hospital, surgical, and procedural details; demographic data; and adverse perioperative events were collected prospectively by Paediatric Anaesthesia Trainee Research Network (PATRN) collaborators. ResultsFor this study, 102 UK hospitals participated and 4232 cases were included in the final analysis; 76% of hospitals did not routinely calculate BMI. In addition, 3030 (71.6%; 95% confidence interval [CI]: 70.2–73.0%) children of healthy weight were compared with 537 (12.7%; 11.7–13.7%) children who were overweight and 478 (11.3%; 10.3–12.2%) children with obesity. Children with obesity (n=71; 14.9%) more commonly underwent (adeno)tonsillectomy than children of healthy weight (n=282; 9.3%; P<0.001; odds ratio [OR] 2.15; 95% CI: 1.58–2.92). Fewer children with obesity (n=365; 77% vs n=2552; 85%) were anaesthetised by consultant anaesthetists (OR 0.62; 95% CI: 0.48–0.79). Mask ventilation was difficult for 3.7% of children with obesity vs 0.6% of children of healthy weight (difference 3.0%; 95% CI: 1.3–4.7%; P<0.001). Comparison with NCMP data demonstrated an over-representation of obesity amongst the paediatric surgical population. ConclusionsThis large multicentre cohort study suggests a concerning prevalence of children with obesity presenting for anaesthesia. These results should be used to inform optimal provision of care for this population and support perioperative healthcare initiatives to address the burden of childhood obesity. Clinical trial registrationClinicalTrials.gov Identifier: NCT03994419.

Evaluations of successful practices in the implementation of green management

The stability of modern socio-economic processes is determined by the rational regulation of the relationship between the optimal provision of production and consumer relations and the scientifically grounded use of the components of the natural environment. In this regard, by analyzing and summarizing various methods of obtaining economic products in demand on the market, as well as by methods of statistical and economic analysis of multidirectional information data, the need to find a multidimensional organizational and management structure that combines productive forms of use and disposal of available production technologies is revealed, subject to full compliance conditions of the minimum possible impact on the natural environment. The main goal of green management is to obtain the maximum possible economic and production effects, which is expressed in the form of the maximum possible level of profit with the maximum satisfaction of consumer demands with the maximum possible extraction of raw materials and energy from the minimum possible amount of components of the natural environment. As a result of the study, it was established that in conditions of violation of natural-natural relationships and natural-climatic conditions of life of modern society, green management is a productive system for the development of promising forms and methods of economic activity in conditions of natural and climatic instability with the receipt of innovative economic products.

European Guideline on Craniofacial Microsomia: A Version for Patients and Families.

A European guideline on craniofacial microsomia was developed within the European Reference Network for rare and/or complex craniofacial anomalies and ear, nose, and throat disorders and published in 2020. The guideline provides an overview of optimal care provisions for patients with craniofacial microsomia and recommendations for the improvement of care. This document seeks to provide a tailored overview of this guideline for patients and their families.

Sociodemographic Characteristics, Gender Identification, and Gender Affirmation Pathways in Transgender People: A Survey Study in Chile.

Understanding the internal diversity of transgender communities is essential for developing optimal, inclusive policies and service provision. To date, research on this topic remains scarce in Chile. We conducted a survey study describing sociodemographic characteristics (age, sex assigned at birth, onset age, nationality, education, sex work, having a partner, having children, sexual orientation, religiousness, gender identification, and gender affirmation pathways). A snowball sample of 377 self-identified transgender adults living in Chile (Mage = 31.88, rangeage = 18-67) was collected for the purpose of this study. According to their sex assigned at birth, 139 participants were female and 238 male. Results revealed that sex assigned at birth was significantly associated with almost all the sociodemographic variables. Eight gender self-identification categories were obtained based on self-declaration. These gender identification categories varied according to sex assigned at birth. Finally, four patterns (clusters) of gender affirmative actions were identified among participants. These patterns indicated that the longer the gender affirmation pathway time, the greater the invasiveness level of the medical procedures used. Sex assigned at birth moderated the association between gender affirmation pathways and gender identity categories. Results were discussed highlighting the heterogeneity found in terms of sociodemographic characteristics, gender identification, and gender affirmation pathways.

Development of clinical guidelines for service provision of functional electrical stimulation to support walking: mixed method exploration of stakeholder views

BackgroundOver the past 20 years Functional Electrical Stimulation (FES) has grown in clinical use to support walking in people with lower limb weakness or paralysis due to upper motor neuron lesions. Despite growing consensus regarding its benefits, provision across the UK and internationally is variable. This study aimed to explore stakeholder views relating to the value of a clinical guideline focusing on service provision of FES to support walking, how people might use it and what should be included.MethodsA mixed methods exploration sought the views of key stakeholders. A pragmatic online survey (n = 223) focusing on the study aim was developed and distributed to the email distribution list of the UK Association for Chartered Physiotherapists Interested in Neurology (ACPIN). In parallel, a qualitative service evaluation and patient public involvement consultation was conducted. Two group, and seven individual interviews were conducted with: FES-users (n = 6), their family and carers (n = 3), physiotherapists (n = 4), service providers/developers (n = 2), researchers (n = 1) and distributors of FES (n = 1). Descriptive analysis of quantitative data and framework analysis of qualitative data were conducted.ResultsSupport for clinical guideline development was clear in the qualitative interviews and the survey results. Survey respondents most strongly endorsed possible uses of the clinical guideline as ensuring best practice and supporting people seeking access to a FES service. Data analysis and synthesis provided clear areas for inclusion in the clinical guidelines, including current research evidence and consensus relating to who is most likely to benefit and optimal service provision as well as pathways to access this. Specific areas for further investigation were summarised for inclusion in the first stage of a Delphi consensus study.ConclusionsKey stakeholders believe in the value of a clinical guideline that focuses on the different stages of service provision for FES to support walking. A Delphi consensus study is being planned based on the findings.

Optimal Loan Loss Provisions and Welfare

We study the welfare implications of optimal loan loss provisions in a New Keynesian model featuring endogenous default risk and inflationary credit spreads. A unique link between provisions, credit spreads and inflation can be employed to enhance macroeconomic stability. Optimal provisions are most effective when dealing with cost-push financial shocks inherent in volatile spreads and the zero bound problem of monetary policy. Relaxing provisioning requirements following a recessionary financial disturbance consistently achieves the first-best outcome while nullifying the value of monetary policy under commitment. In contrast, deflationary demand shocks warrant an optimal rise in provisions, which inflate prices yet mildly contract output.

Social Insurance, Information Revelation, and Lack of Commitment

We study optimal provision of unemployment insurance in a model where agents privately observe arrival of job opportunities and government’s ability to commit is imperfect. Imperfect commitment imp...

The impact of first COVID-19 peak on patient referrals to Liaison Psychiatry Service and staff perception about service provision in Birmingham and Solihull Mental Health Trust Birmingham - a service evaluation project

AimsBased on recommendations from the Royal College of Psychiatrists, this project aimed to evaluate the impact of the first peak of the COVID-19 pandemic on referral patterns to the Queen Elizabeth Hospital Birmingham (QEHB) Liaison Psychiatry (LP) service. Additionally, we aimed to explore staff experiences in LP services across Birmingham and Solihull Mental Health Trust (BSMHFT) in order to generate Trust recommendations promoting optimal healthcare provision amidst the on-going pandemic.MethodA mixed method service evaluation was conducted using quantitative and qualitative analysis. Quantitative methods involved reviewing referrals made to the QEHB LP service from March to June 2020, compared with the equivalent time period in 2019. Data were retrospectively extracted from the electronic clinical databases RIO and PICS, and subsequently analysed using Microsoft Office. The number of, and reasons for referrals to LP were identified, whilst focus groups were conducted to explore the subjective experiences of staff working across BSMHFT LP services.ResultBetween 1st March and 30th June 2020, 984 referrals were made to the QEHB LP service, compared to 1020 referrals in 2019, representing a 3.5% reduction. From 2019 to 2020, referrals due to psychotic symptoms and deliberate self-harm rose by 12.8% and 14.1% respectively, whilst referrals for drug and alcohol-related causes reduced by 28.3%. A significant increase (150%) in referrals for medication or management advice was seen. Focus groups indicated that staff perceived an initial reduction in number of referrals, but an increase in the acuity of patient presentations.Staff reported anxiety around contracting and transmitting SARS-Cov-2, exacerbated by uncertainty around patients’ COVID-19 status. In QEHB, sixty-five of the 984 referrals (7%) had a positive SARS-Cov-2 PCR swab, with the remaining 919 referrals being either negative (68%) or unknown (25%). Ninety-six percent of consultations were conducted face-to-face in QEHB. There were conflicting views amongst staff regarding whether more consultations could have been conducted remotely. Furthermore, varying perceptions of support and communication from both the physical and mental health trust were reported.ConclusionQuantitative data indicates that COVID-19 impacted LP healthcare provision in BSMHFT. Whilst referral numbers remained similar between the equivalent period in 2019 and 2020, a change in the nature of referrals to LP at QEHB was seen. This was corroborated by qualitative data which highlighted a perceived change in acuity of referrals. These findings have been disseminated across the Trust and subsequent recommendations are being implemented during the on-going pandemic.

Organization of Medical-Social Services for the Elderly Internally Displaced persons from the ATO Zones at the Level of Primary Medico-Sanitary Care

This paper is concerned with the organizationofmedical-socialservicesfortheelderly internally displaced personsfrom theATO zonesat the level of primary medico-sanitary aid.Sociologicalinvestigationsusingpersonal questionnairesandexperts’evaluationshave shown thatsocial-psychological characteristics oftheelderlyinternallydisplacedpersons(IDPs),Theirsocialadaptation, inadequatefinancingandlowlevelofmedico-socialcare,as well as their preferences make it necessary organize healthmonitoringsystem, treatment, rehabilitation and long-term care by family doctors, information centres, day-time stayand rehabilitation centres.WehavedevelopedthemodeloforganizingambulatoryservicesfortheelderlyIDPsat the level of primarymedico-socialcare(PMSC)that would include structural modernization and optimization of its optimal provision. Inouropinion, thismodelismostaccessibleandeconomicallygrounded. It allowsprovide interaction and co-operation of the professionals of health and social care institutions, optimization of standards and principles of medical care. Implementationofthismodelasmostaccessibleandeconomicallygroundedwould allowinteractionandcooperationoftheprofessionalsofhealthcareorganizationsandsocialprotectionsettings.Introductionofthismodel,asmostaccessibleandeconomicallygrounded,would allowensureinteractionandcooperationoftheprofessionalsofhealthcareand social protection institutions, optimizeobservation of the medical care standards and principles. Wehavedevelopedmethodologicalapproachesfortrainingthephysiciansandhealthcare-giversreceivingkeyknowledgeanddeveloping self-carehabitsfortheelderlyIDPsattheir homesconsideringtheirmedico-socialandpsychologicalneeds.

A Systematic Review of Discrete Choice Experiments in Oncology Treatments.

As the number and type of cancer treatments available rises and patients live with the consequences of their disease and treatments for longer, understanding preferences for cancer care can help inform decisions about optimal treatment development, access, and care provision. Discrete choice experiments (DCEs) are commonly used as a tool to elicit stakeholder preferences; however, their implementation in oncology may be challenging if burdensome trade-offs (e.g. length of life versus quality of life) are involved and/or target populations are small. The aim of this review was to characterise DCEs relating to cancer treatments that were conducted between 1990 and March 2020. EMBASE, MEDLINE, and the Cochrane Database of Systematic Reviews were searched for relevant studies. Studies were included if they implemented a DCE and reported outcomes of interest (i.e. quantitative outputs on participants' preferences for cancer treatments), but were excluded if they were not focused on pharmacological, radiological or surgical treatments (e.g. cancer screening or counselling services), were non-English, or were a secondary analysis of an included study. Analysis followed a narrative synthesis, and quantitative data were summarised using descriptive statistics, including rankings of attribute importance. Seventy-nine studies were included in the review. The number of published DCEs relating to oncology grew over the review period. Studies were conducted in a range of indications (n=19), most commonly breast (n=10, 13%) and prostate (n=9, 11%) cancer, and most studies elicited preferences of patients (n=59, 75%). Across reviewed studies, survival attributes were commonly ranked as most important, with overall survival (OS) and progression-free survival (PFS) ranked most important in 58% and 28% of models, respectively. Preferences varied between stakeholder groups, with patients and clinicians placing greater importance on survival outcomes, and general population samples valuing health-related quality of life (HRQoL). Despite the emphasis of guidelines on the importance of using qualitative research to inform attribute selection and DCE designs, reporting on instrument development was mixed. No formal assessment of bias was conducted, with the scope of the paper instead providing a descriptive characterisation. The review only included DCEs relating to cancer treatments, and no insight is provided into other health technologies such as cancer screening. Only DCEs were included. Although there was variation in attribute importance between responder types, survival attributes were consistently ranked as important by both patients and clinicians. Observed challenges included the risk of attribute dominance for survival outcomes, limited sample sizes in some indications, and a lack of reporting about instrument development processes. PROSPERO 2020 CRD42020184232.

Concept of Productivity Levels in Modeling Sugar Beet Yields

Various approaches have been used to model the productive potential of sugar beets under the conditions of unstable moistening of the steppe zone of Russia. This paper considers the general theoretical approach to the functional description of most of the processes of plant growth and development in ontogenesis, as well as of any organism, which is determined by the conversion of bioclimatic resources into the biological mass of plants. Through mathematical modeling, the potential productivity of sugar beets in the absence of limiting factors, with optimal provision of plant life factors, was determined. The second level of modeling sugar beet productivity was performed for the conditions of unstable moistening in the steppe zone of Russia, where soil moisture is a factor limiting the productivity of the crop. To predict productivity in conditions of moisture deficiency, the study used plant organs and soil processes as a model, since they determine the availability of water and nutrients for the plant root system. Given the practical applications of the data for real production conditions, the data obtained in the first and second levels of crop productivity modeling were compared with the actual yield data obtained empirically. The maximum rates of dry matter accumulation for the conditions of the steppe zone of Russia in the absence of limiting factors was not limited to the supply of photosynthetically active radiation (PAR) and could produce up to 16 t/ha of dry matter root crops. With a moisture deficit during the beginning of row closing (from the 45th to the 75th day of the growing season), there was almost no increase in the dry matter of the plant mass, which reduced the potential productivity of sugar beets by 50%.&#x0D; Keywords: crop modeling, sugar beet, potential crop, photosynthesis, moisture supply

Optimal infrastructure reinvestment in urban rail systems: A dynamic supply optimisation approach

The state of infrastructure in many developed countries around the world is an increasingly pressing issue, with mounting costs the longer repairs are deferred. In today’s rapidly urbanising world, the urban rail network is particularly critical, since infrastructure failures can have severe economic consequences for both the operator’s finances and user time costs. This paper thus provides a system-level model of welfare-oriented supply optimisation that integrates asset management with the literature on optimal pricing and capacity provision. Using a simulation approach and calibrating with London Underground data, this paper delivers three key contributions. First, the economic efficiency of long-term capital planning is highlighted, with up to an 87% welfare gain when comparing a 40- versus 5-year planning horizon. Second, in general, the longer the planning horizon, the higher the annual welfare, demand, asset condition, fare and supply, in the steady-state. Third, the analysis explores why policies in reality diverge from the welfare optimum: we show that election cycles can have a detrimental effect, with increased asset neglect and volatility in spending. Economic efficiency improves in the short-term at the expense of the long-term; significant intervention is needed to break this downwards trend, as also reflected in various rail systems’ histories.

ELABORATION OF IMPROVED HYDROPONIC INSTALLATIONS

Hydroponics is a perspective direction of development of modern agriculture that provides perennial growing of main species of vegetables and greenery on small areas and with minimal expenses of water and fertilizers. This technology allows to get large enough harvests of fresh vegetables in big cities including office and living premises. Last time entrepreneurs and inventors pay a lot of attention for elaboration of more effective methods of hydroponics and equipment for their realization in direction of decrease of using areas, economy of water, nutrients and increase of air supply and plants capacity. There are several known methods of hydroponics: static solution culture, continuous-flow solution culture (NFT), deep water culture, passive sub-irrigation, flood and drain sub-irrigation, run-to-waste system, top-fed deep water culture, rotary system, aeroponics, fogponics. Commercial and industrial use got the first three from above mentioned methods. Herewith the method of static solution culture does not provide of necessary saturation of plant’s roots with air. Under realization of the method of continuous-flow solution culture are possible little buffering against interruptions in the flow (power outages), water logging in some channels, besides there are limitations for maximal length of channels (12 – 15 m). The method of deep water culture in industrial scales is used mainly for growing of lettuce. The other mentioned methods are not enough effective from point of view of commercial utilization. The improved hydroponic installations, presented in the article, were elaborated with consideration of such demands: versatility of use (a possibility of growing of various species of plants); harmonies optimal provision of crops with water, nutrients, light and air; maximal use of premise’s space; a possibility of re-space during of the growth period, increase of area for each plant and support of its stalk and sprouts. Also, the formulas for definition of main parameters of the elaborated installations are presented in the article.

Barriers to optimal breast milk provision in the Neonatal Intensive Care Unit (NICU)

Barriers to optimal breast milk provision in the Neonatal Intensive Care Unit (NICU)